| NPI | 1134475817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 118791) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ 37LC00160700) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1642 AD) | |
| 104100000X Social Worker (Licence: NJ 44SL05623300) | |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2020-08-05 |